Holmium laser enucleation of the prostate (HoLEP) is an increasingly used safe and effective alternative for the management of benign prostatic hyperplasia (BPH). Researchers studied the outcomes of this treatment in patients age 80 and older and found that HoLEP is safe and effective among the elderly, with similar outcomes to those observed in younger patients.

The increasing aging population has been accompanied by a larger number of patients with BPH and consequent lower urinary tract symptoms (LUTS) and bladder outlet obstruction. Such symptoms are usually managed with pharmacological solutions or surgery, if conventional medicines fail.

Surgical approaches include open prostatectomy (OP) and transurethral resection of the prostate (TURP), considered the gold standard for the surgical treatment of symptomatic BPH. However, elderly patients may not be suitable candidates for TURP, as they usually present serious comorbidities, such as severe hypertension, myocardial infarction, liver and kidney dysfunction, or diabetes.

In recent years, HoLEP has been increasingly used as a safe, reproducible, and effective surgical management choice for BPH management. Despite the growing positive evidence in favor of HoLEP over other surgical options, little is known about the effect of age on the efficacy and morbidity of HoLEP.

Researchers evaluated 579 patients who underwent the HoLEP procedure performed by a single surgeon. The perioperative and functional outcomes were assessed in terms of three age groups: 50-59 (group A, 44 patients); 60-69 (group B, 253 patients); 70-79 (group C, 244 patients); and 80 and older (group D, 38 patients).

Before surgery, patients age 80 and older had a significantly higher presence of hypertension, total prostate volumes, urinary retention, and anticoagulation use, among other functional measures.

Following surgery, patients who were 80 and older had longer hospital stays. The incidence of complications was similar across all groups. Furthermore, all the patients who participated in the study showed significant improvements in functional outcomes after HoLEP and, six months post-surgery, there were no significant differences in IPSS (International Prostate Symptom Score), quality of life, and Qmax (maximum urinary flow rate) among the different groups.

The researchers concluded that, compared to younger patients, patients aged 80 and older “had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.”

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Margarida graduated with a BS in Health Sciences from the University of Lisbon and a MSc in Biotechnology from Instituto Superior Técnico (IST-UL). She worked as a molecular biologist research associate at a Cambridge UK-based biotech company that discovers and develops therapeutic, fully human monoclonal antibodies.

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